Provider Demographics
NPI:1922153766
Name:KADING-WHEELER, TERRI (LCSW)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:KADING-WHEELER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 ERIE ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-4443
Mailing Address - Country:US
Mailing Address - Phone:262-632-2081
Mailing Address - Fax:
Practice Address - Street 1:6233 DURAND AVE
Practice Address - Street 2:SUITE F
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4961
Practice Address - Country:US
Practice Address - Phone:262-554-8165
Practice Address - Fax:262-554-8152
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI584-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39599300Medicaid